Basilar impression is a pathological abnormality in the area of the cervical vertebrae. The abnormality is seen in the transitional craniocervical region, with an impression developing on the second vertebra of the neck. In particular, the dens axis is affected. Because the basilar impression occurs near the foramen magnum, the condition narrows this segment.
What is basilar impression?
Basically, basilar impression represents a condition that occurs in the craniocervical junction area. In this condition, the floor in the posterior fossa of the skull bulges in the shape of a funnel. The bulge closes around the so-called foramen occipitale. In principle, a basilar impression is either congenital or acquired during life. In genetic forms of basilar impression that exist from birth, various syndromes and diseases are possible. For example, basilar impression occurs frequently in Arnold-Chiari syndrome and Klippel-Feil syndrome. In addition, the anomaly often forms in the context of dysplasia at the atlas. Acquired forms of basilar impression often result from trauma, for example, injuries or accidents that compress the area in the axial direction. In addition, basilar impression forms in some cases in the context of osteomalacia, rheumatoid arthritis, and weaknesses of the connective tissue. In this case, the disease often occurs together with Ehlers-Danlos syndrome as well as Marfan syndrome. Finally, basilar impression sometimes develops together with a condition called osteodystrophia deformans.
Causes
The causes of the typical anomalies of basilar impression vary. Basically, a differentiation must be made between congenital and acquired manifestations of the disease. In the majority of cases it is a congenital disorder of development. With much lower frequency, the disease occurs together with osteodystrophia deformans, tumors of the bones or osteomalacia. In addition, associations of the basilar impression with other malformations are seen in numerous patients. These anomalies affect, for example, the atlas. Basilar impression also occurs frequently in association with Arnold-Chiari syndrome, Klippel-Feil syndrome, or syringomyelia.
Symptoms, complaints, and signs
The typical symptoms of basilar impression vary depending on the individual case of the disease. In some cases, the disease has an asymptotic course over a long period of time. The first signs of basilar impression often manifest as pain in the head and neck. However, the pain symptoms tend to be nonspecific and rarely clearly indicate the actual disease. If the disease progresses further, the symptoms also intensify. In most cases, affected patients suffer increasingly intense basilar impression symptoms. For example, nerves in the brain or brain stem are compressed. In addition, the supply of blood is impaired by the pathological abnormalities associated with basilar impression. As a result, various complaints develop in the diseased individuals. Many patients suffer from general symptoms such as nausea, vomiting, and attacks of vertigo. In addition, syncope and tachycardia occur. Some individuals show paresis or paresthesias, and dysphagia or dysarthria may also occur in association with cranial nerve crushing.
Diagnosis and course
Basilar impression usually progresses without symptoms in most affected individuals. In a small group of affected individuals, the typical symptomatology develops from the third or fourth decade of life. One of the first symptoms is usually a long-lasting headache. In an advanced stage of basilar impression, the affected patients suffer from dizzy spells, outbreaks of sweating and tachycardia. Such symptoms of the disease are most apparent when affected individuals turn their heads or exert themselves physically. Once the medulla of the cervical spine has been chronically damaged by the disease, the so-called pyramidal tract signs develop on both sides. In connection with this, the affected patients suffer from disturbances of sensitivity in the limbs.In the medulla oblongata, typical cord symptoms result. If the medulla oblongata is further damaged, individuals suffering from basilar impression exhibit symptoms such as cerebellar ataxia, paresis of certain nerves of the brain, and difficulty swallowing. In addition, Horner syndrome may develop in such cases. After taking a history of the affected patient, the physician performs clinical diagnostic procedures. In the process, he first examines the affected person externally. Signs such as a relatively short neck and various neurological anomalies already point to the basilar impression. In the further course of establishing the diagnosis, the attending physician uses various imaging procedures. X-ray examinations as well as MRI and CT scans are common.
Complications
In most cases, this disease causes pain in the neck, head, and throat. The pain does not have to be immediate, and the course of the disease is often asymptotic, which greatly prevents early diagnosis in particular. Due to the pain in the head area, the affected person is limited in his actions and in everyday life. The pain can also lead to depression and other psychological complaints. As a rule, the pain increases as the disease progresses. The brain can also be affected, with nerves being compressed. Paralysis or perceptual disturbances may occur. The extent of these complications depends greatly on the severity of the symptoms. In many cases, however, vomiting and dizziness occur. Many patients also suffer from coordination disorders. The dizziness can lead to sweating. Due to the sensory disturbances, certain perceptions may be limited, so that the quality of life of the affected person decreases extremely. As a rule, it is possible to treat the impression surgically. In this case, no particular complications occur and the symptoms disappear completely.
When should one go to the doctor?
In the case of persistent back pain associated with unusually intense nausea, a physician must be consulted immediately, as a basilar impression may be present. Prolonged headache is also typical of the condition, occurring primarily with physical exertion and rotational movements of the head. If this headache occurs in conjunction with dizzy spells, sweating and an increased pulse, a basilar impression is possibly present. The symptomatology described typically presents in the third or fourth decade of life. Basilar impression requires an immediate visit to the doctor, because if left untreated, the symptoms continue to increase and often lead to depression and other psychological problems. It is therefore advisable to talk to your family doctor as soon as the first symptoms appear. He or she can rule out or diagnose basilar impression and then suggest the appropriate treatment. The actual treatment, usually a surgical procedure in which the brain’s main hole is widened, should then be carried out as soon as possible. Since complaints can always recur despite successful treatment, the responsible physician should be consulted on an ongoing basis. If complications such as postoperative bleeding or scarring occur, another visit to the hospital is required.
Treatment and therapy
Basilar impression is treatable by surgery. Neurosurgical procedures are primarily used. The occipital foramen is dilated and stabilized as needed. If treatment-related measures are used timely and successfully, the prognosis of basilar impression is comparatively good.
Outlook and prognosis
The prospects for cure of basilar impression are favorable with early treatment and basically stable health. The outlook is equally good for both congenital and acquired impression. Corrective surgery is performed. The surgical intervention is associated with the usual risks and side effects. Depending on the severity of the condition, it represents a challenge for the treating physician and should only be performed by an experienced medical professional. For some patients, the intensive procedure is difficult to tolerate. If the patient is in poor health, there is an increased risk of complications. The subsequent healing process takes several months. Normally, the patient is then discharged from the treatment as cured.Recurrence of basilar impression is considered impossible. Once complications have occurred, they should be treated in parallel. In addition, the patient should attend a check-up at regular intervals. Without medical care, the patient’s health condition cannot be improved. In mild cases of the disease, there are no further dangers. However, in severe cases, blood vessels may be entrapped. If the cause is congenital, these patients experience sequelae within the natural process of growth and development, resulting in a life-threatening condition. If the entrapped blood vessels burst, a stroke is imminent.
Prevention
Prevention of basilar impression tends to be difficult because of the large number of potential triggers. According to the current state of research, congenital forms of the disease cannot in principle be effectively prevented.
Follow-up
The extent to which follow-up is necessary after treated basilar impression depends on the outcome of surgery. Patients cannot prevent disease. In most cases, it is a congenital developmental disorder that can be successfully corrected. The earlier patients start treatment, the better the chances of success. Often there is no need for follow-up care. The patient is discharged as cured and can go about his or her normal professional and private life. If typical symptoms persist after surgery, a medical professional can clearly identify the basilar impression during an external inspection. X-rays and computer tomographies also provide clarity. Often, physical therapy is sufficient to stop the symptoms. The number of sessions depends on the individual pattern of complaints. Complications are the exception with a basilar impression. They mainly affect the psyche. Depression and a constant feeling of malaise are permanently present as a result of the pain in the head, neck and throat area. Even dizziness and coordination problems may remain. Not infrequently, prolonged treatment becomes necessary in these severe cases. Psychotherapy and administration of medication to relieve pain follow. In principle, the length of follow-up can be shortened by starting therapy early.
Here’s what you can do yourself
Basilar impression cannot be cured naturally or by self-help measures. Therefore, when the corresponding symptoms occur, an early visit to the family doctor is strongly recommended. He or she can quickly clarify the causes of the severely debilitating symptoms and, if the diagnosis is positive, quickly initiate the necessary treatment steps. The sooner targeted treatment begins, the more certain it is that progression of the disease can be avoided. This has a twofold effect on maintaining quality of life. First, the rapid initiation of appropriate medical measures prevents further development of the painful symptoms and any sensory disturbances that may occur. Secondly, it reduces the risk of psychological sequelae that can arise from the everyday impairments. The longer the basilar impression remains untreated, the further the health risks increase. Self-treatment with painkillers without a medical diagnosis should therefore generally be avoided. It cannot eliminate or reduce the actual causes of the disease. Depending on the severity of the disease, physiotherapeutic measures may be used as part of the medical treatment. In this case, the instructions of the physiotherapist should be followed in everyday life. However, the most important self-help measure for basilar impression is a prompt visit to the doctor.
